Billing: Invest in compliance

Q. What steps can I take to prepare for audits under managed care contracts? 

By Kit Shellhouse 

A. As a provider, preparing for audits under managed care contracts can be a chore, but the key is to understand the requirements and expectations well in advance. Invest time in reviewing your managed care contracts to grasp all requirements, including billing procedures, documentation standards and compliance obligations. This foundational knowledge is crucial for staying well-informed about your contracts. Implement solid documentation practices by using standardized forms and templates for consistency and accuracy.  

Conducting internal audits is a fundamental part of being proactive, focusing on specific areas such as coding and timely submissions. Internal audits allow you to correct issues before an external audit. Use the analytics from these audits to tighten your best practices and retrain staff, addressing concerns effectively. Ongoing staff training on compliance requirements and audit preparation is essential to ensure familiarity with the latest regulations and managed care contract requirements. Providers can stay informed by subscribing to industry newsletters, attending webinars, and participating in professional and state associations. 

Also ensure all records are easily accessible and conduct mock audits to identify and address potential weaknesses, taking prompt corrective actions. Set expectations with a solid compliance program that includes policies and procedures for preventing, detecting and responding to compliance issues, managed by your compliance officer. Encourage a culture of transparency by implementing an anonymous compliance hotline for your staff.  Finally, harness technology to streamline internal processes such as tracking compliance, identifying potential issues early on, and trending issues to prevent recurrence.  

By following these steps, you'll be well-prepared for any audit and can ensure compliance effectively. 

Kit Shellhouse is director of business development for the van Halem Group. Reach her at Kit@vanHalemGroup.com.